Healthcare Defined: “Copay”

Sometimes, healthcare can seem like a whole different language. In this series, we break down some common healthcare terms into plain English.

Copay / copayment (noun) — A fixed amount you pay for a healthcare service when you visit the doctor. The flat fee depends on the type of doctor you see or service. Some healthcare plans also have a copay when you fill a prescription.

This definition seems simple, but like most things in healthcare, it’s more complicated than you think. Let’s break it down.

Every time you see a doctor, you pay a copay, a flat-fee your general practitioner or specialist charges you for using their services. The specific amount is outlined in your insurance plan, so make sure to read the fine print. If you visit the doctor or pharmacy often, you’ll want to choose a plan that has a low copay to save money.

Copays are an effort to make healthcare prices transparent, but copays can have some complicated relationships with other parts of your healthcare plan.

Before you reach your deductible, which is the maximum amount of money you have to pay for your insurance to help cover your medical expenses, you will foot the entire bill for a procedure or prescription. Once you’ve hit your deductible, your coinsurance kicks in, meaning you’ll start being responsible for a set percentage of medical costs. This is where your medical expenses get tricky, especially since your copay does not count towards your deductible, but rather goes towards your out-of-pocket maximum.

An example will help clear things up: you sprained your foot playing soccer and think, “Boy, I’m so lucky as I recently met my deductible, and insurance will cover this trip to the doctor.” But now, you’re charged for your copay and coinsurance. So, before you leave the doctor’s office, the receptionist asks you to pay your $20.00 copay upfront. 2 weeks later, you receive a bill for an additional $20.00 — this is your coinsurance, which is 20% of any medical bill total (20% of the $100.00 bill is $20.00). Thus, for this sprained foot, you had to pay $40.00.

People tend to think that once they reach their deductible, they’ll be free of medical bills. However, insurance will only cover all your medical expenses once you’ve met your out-of-pocket maximum, which includes your deductible, coinsurance and copays.

At SingleCare, we want to make things a little more straightforward—and cheaper.

We believe being healthy shouldn’t be so expensive, which is the reason why we’ve created a transparent, retail environment for healthcare services. Whether you have insurance or not, visit singlecare.com to search for the services you need and compare costs without the hidden fees or limits. We’ve pre-negotiated rates with doctors, so the price you see is the price you pay.